Medical RAC Audits Reviewed by Statistician Frank Cohen Medical RAC Audits Reviewed by Statistician Frank Cohen

Practices Gear Up For 90 Days Of MIPS Reporting

By Grant Huang, CPC CPMA, Director of Content at DoctorsMangement  

Halfway through the first reporting year for the Merit-based Incentive Payment System (MIPS), some practices are only doing the bare minimum reporting to avoid a 2019 Medicare pay cut. But other groups, particularly larger groups, are committed to reporting as much as possible to earn the biggest bonus they can.

“My goal is to get 70-plus points per provider,” says Joseph Mathews, practice administrator at Advanced Orthopaedics & Sports Medicine in Houston, Tex. “This is the first year so I don’t think many people will be going for it all the way. Very few people are going to try that hard, so we hope to be among the very few.”

In addition to the maximum positive adjustment of +4% in 2019, the providers with the highest points (100 points total are possible) would receive a share of additional bonus money from a $500 million pool. These providers are termed “exceptional performers” by CMS and few practices have their sights on meeting this standard in 2017, Mathews believes.

His practice plans to report for 90 days, beginning in August. The 90-day reporting option now appears to be gaining popularity among practices that are pushing for larger incentive bonuses. One reason is a major new clarification from CMS (see sidebar, pg. 5).

At OrthoIllinois in Rockford, Ill., the plan is to report for 90 days starting in the early fall, says Terry Anderson, director of informatics. She shares the same goal as Mathews’ group: Hitting at least 70 points for each of their MIPS-eligible providers. So far, the toughest task at the 34-provider group has been sorting through the available MIPS measures to determine which give the most “bang for the buck,” Anderson says. “That was daunting. But once we had the measures we wanted, so far I think it’s been easier than expected.”

What to report for 90 days

For 2017, only three of the four MIPS components will be counted toward your score. The fourth component, Cost Performance, will be calculated automatically by CMS (as it will be in all MIPS years), but will not count toward your final score. Thus in 2017 a full slate of MIPS reporting would consist of the following, for 90 consecutive days:

Reporting at least six Quality Performance measures, of which one must be an Outcomes measure;

Reporting one High-weight or multiple Medium-weight activities under the Improvement Activities component; and,

Reporting all Base measures for the Advancing Care Information component (ACI; previously known as EHR meaningful use).

There are four ACI Base measures for the 2017 transition year:

Security Risk Analysis (attest yes/no)

E-prescribing (report numerator/denominator)

Health Information Exchange (report numerator/denominator)

Providing Patient Access (e.g. via patient portals)

Practices: A 4% bonus is a big deal

Just how much is a +4% Medicare payment boost worth? It depends on the practice, but for both groups interviewed, the dollar value is significant. Mathews estimates his Houston-based group, which has 26 providers (including six physical therapists), stands to earn about $180,000 based on a 4% Part B payment boost. This doesn’t count any exceptional performer money.

At OrthoIllinois, CEO Don Schreiner estimates that a 4% boost would be worth approximately $300,000, again without exceptional performer money. “That $300,000 would reduce our overhead by about 0.8% … it would ultimately represent a 1.5% increase to our bottom line,” he says. There’s no question that a large group like OrthoIllinois enjoys a major advantage, being able to hire someone like Anderson, the informatics director. “We’re fortunate to have somebody like Terry and I just don’t know how a smaller practice could do this without a dedicated person.”

Grant Huang, CPC, CPMA (  The author is Director of Content at DoctorsMangement.